In her blog post, The High Cost of Out-of-Pocket Expenses Judith Graham of the New York Times notes that health care costs often come as a shock to people who thought that Medicare covered everything until they experienced a health crisis.
According to Graham, ‘Although it is a fairly comprehensive program, Medicare doesn’t cover everything. Besides long-term care, traditional Medicare also does not pay for companions or homemakers who help older people get dressed, eat, bathe and cook; dental services; hearing aids and eyeglasses.’
The biggest missing link: ongoing proactive guidance to help people avoid crises that cost them money and negatively impact their overall well-being. Looming Medicare reimbursement changes due to the Affordable Care Act (ACA) and the fiscal cliff may further erode what’s available.
‘We hear from many, many professional health care referral sources that they are concerned about their clients’ financial resources. So are we,’ stresses Joel Theisen, CEO & Founder of Lifesprk. ‘That is why we truly believe that people need to go beyond private-pay home care. As experts in that field, we learned a long time ago that the traditional private-pay home care model is transactional in nature. It doesn’t have the proactive guidance that is critical to helping people reduce their costs and more importantly, to get off – and stay off – the roller coaster of crises.
‘Our goal at Lifesprk is to actually help people reduce their out-of-pocket expenses,’ explains Theisen. ‘Ideally, if we get involved early enough, we can save people thousands of dollars by working to prevent crises that not only cost them money but reduce their well-being and functionality.
He shares the story of one client Vern Gillespie. ‘Vern was living in a skilled nursing facility (SNF) and told that he would never live on his own again. But Vern was determined – he wanted to return home to ride his lawn mower. That was his spark. His brother decided to call Lifesprk to see what might be possible.’
Fast forward four years: Vern is busy doing what he wants. He’s living at home, mowing his own lawn, grocery shopping, attending church weekly, and saving thousands of dollars in caregiving costs. The keys for Vern were getting Lifesprk’s Life Care Management involved. The proactive guidance made all the difference.
Here are some tips for helping clients to reduce their out-of-pocket expenses:
- Give them the big picture: Too often people in crisis are looking at the world through a narrow straw. Help enlarge their view. Share your more global perspective of what you see occur every day with people who are experiencing readmissions and the value of proactive guidance. People often just want to put the entire problem behind them and move on. While certainly understandable, encourage them to step back to ask how they can build proactive guidance into their lives to prevent another health care escalation in the future.
- Frame it: Sometimes it is as simple as posing the question – ‘Would you rather spend $10,000 on another health crisis and risk losing your independence, or would you rather spend $300 monthly to protect your independence, stay in control and live life on your terms?’
- Give them the facts: To truly make an informed decision, people need to better understand their options and what may be best for them. All providers are not alike. There are gaps even in Medicare and government funded services. Help them understand the value of proactive guidance and where they can find it. Help them understand what will happen when they go home. Give them questions they should ask.
For more suggestions on helping your clients reduce their out-of-pocket expenses, contact Beth Nemec, Director of Sales for Lifesprk at 952-345-8770 or schedule a free consultation.